People can recover from mental illness

By Daniel Fisher, M.D., Ph.D.

Research carried out at the National Empowerment Center has shown that people can fully recover from even the most severe forms of mental illness. In-depth interviews of people diagnosed with schizophrenia have shown that these people are capable of regaining significant roles in society and of running their own lives. Though they have recovered from their mental illness they, as everyone, continue to heal emotionally. In most cases they no longer need medication and use holistic health and peer support to continue their healing. Our findings are consistent with long term studies carried out in this country by Dr. Courtenay Harding and colleagues, and in Europe by Dr. Manfred Bleuler and Dr. Luc Ciompi. These workers have shown that over a 20-30 year period a majority of people recover from even the most severe forms of mental illness. In addition, cross cultural and historical studies indicate that chronic mental illness is recent phenomenon of Westernized countries. Recent studies by the World Health Organization show that the rate of recovery from severe mental illness is much better in third world countries than in Western industrialized countries. Historical evidence points out that the rates of recovery were much higher during the 1830-40¹s in this country when there was a much more optimistic view of recovery. (See accompanying article on moral therapy.)

In spite of all this evidence, most people in this country still believe that when a person has been labeled with mental illness they can never fully recover. As we pointed out in our previous newsletter, even most rehabilitation professionals believe that mental illness is a permanent condition. We believe that fear is a large factor in perpetuating the myth of no recovery. Those persons who are temporarily labeled normal are afraid that they too could enter the realms of madness. They are more comfortable thinking that those of us who have displayed severe emotional distress are qualitatively different than they are, that somehow we have a genetically-based brain disorder that they don¹t have. This myth could not be continued if people labeled with mental illness fully recover, and no longer need medication. In fact, if we are to better understand recovery from mental illness we need to see that anyone could be labeled mentally ill. We need to see the connection between recovery and healing. (See the expanded diagram of our empowerment model.)

Long Description for Graphic Entitled “Empowerment Model of Recovery from Mental Illness”

The graphic illustrates an oval pattern with various descriptions located around the perimeter and in the interior. There is a counter clockwise rotation indicated by arrows.

Picture the oval as the face of a clock, and you start at 3:00 which is labeled as “Balanced and whole”. There is an arrow which flows towards 2:00 which is labeled as “Loss/Stress”. From here the arrows split, either running to 12:00 which is labeled as “Severe Emotional Distress (SED)” or towards the center which is labeled “Sufficient supports, & coping”.

From “Sufficient supports, & coping”, the arrow points down below the center to a position labeled as “Emotionally Distressed” which you will come to again as the flow continues from the top.

Going back to the top, there is an arrow which points down to “Severe Emotional Distress (SED)”, or it continues counter clockwise to about 10:00 which is labeled as “Insufficient supports & coping”.

From here, it flows to 9:00 which is labeled as “Mentally Ill”, and continues to flow towards 8:00 which is labeled “Recovery from mental illness through self-management & social role”.

From here, the arrows split with a sweeping motion towards the center which is labeled as “Mentally Distressed” (which is just below “Sufficient supports & coping”). From Emotionally Distressed, the arrow sweeps down to the 5:00 position which is labeled as “Healing”.

Going back to 8:00 (“Recovery from mental illness through self-management & social role”) the other arrow sweeps along to 5:00 which is labeled as “Healing”. Form here, the arrow sweeps up to where we started at the 3:00 position which is labeled as “Balance and whole”.

If you look at the right side of the diagram you will see the state of being balanced and whole. This is an idealized state, which may exist in utero, and may be a goal we strive much of our life to return to. In fact, each of us once blissfully floated in a dream-world of our mother¹s embracing fluids. We could hear the gentle, rhythmic whoosh, whoosh, whoosh of her heart- beats. We could feel the firm, protective surroundings of her uterine wall as it massaged our growing body. Perhaps we tasted her salty fluids rich with nutrients and love. Is this not the appeal of the ocean? Do not its waves remind us of her heartbeat? Do not its salts remind us of her salty water bed, or perhaps of an earlier existence among the fish themselves? And when we immerse our bodies and feel the surging power of the swells we feel at one with our deepest self, the self we experienced in our earliest life. Our deepest self is whole and in connection with all other living beings. From that carressingly warm ocean of our mother¹s womb we are rudely awakened alone in the glare of the cold, dry world outside. We spend much of the rest of our life trying to re-experience the bliss of having a harmonious deep self in that earliest state.

We seek bliss in many forms. Foremost we seek it in our relationships with others, and with ourselves in our art, our play, and our work. In our relationships with others, we will go to great lengths to be near others who bring us back in touch with those memories of our mother (earth¹s) womb. We try to provide such an environment for newborn babies and in so doing we experience some of that bliss ourselves. We coo a gentle rhyme and rock her to a rhythmic beat. The harmonious play of lights and colors pleases her. But we can not hold her forever. She needs to walk, swim, and speak, as she travels into worlds beyond ours. She will return to have us help her with her laundry, but she will be on her own power most of the time. We all have needed to make this move out of our parents’ home and to form our own nest. We needed to believe in our own capacity to do so. We needed to believe in ourselves. We need others along the road who believe in us and believe in our capacity to live our own life. We need others who are not threatened by our leaving because they have a full life of their own. We all need to develop an inner soothing, an inner cooing, an inner whoosh, whoosh. However, life is filled with many losses, conflicts and traumas, as shown in the diagram. They can lead to varying degrees of emotional distress.

The challenge we all face is how to integrate after loss or conflict and return to a greater wholeness of self. This is accomplished through social supports, coping, and other resources. This we call the process of emotional healing and appears in the lower right side of the recovery diagram. Some people¹s losses may be greater and/or their inner resources more limited. Instead of healing, those people may enter into a state of severe emotional distress seen at the top of the diagram. They still are in a major, accepted social role, but they may need to go through a state of severe emotional distress to experience the self-renewal which Dr. John Weir Perry has written of in The Far Side of Madness. There may be a state of social withdrawal. Their thoughts become more personalized. If the person¹s social, cultural, economic and psychological worlds are able to support him as he goes through this deep reintegration process, his thoughts will return to shared reality. Then he can maintain his social role. The person¹s emotions calm down and he can proceed with the healing we all go through. If on the other hand, there are not sufficient outer and inner resources, and the person is no longer able to maintain a major social role, he is placed in the role and assumes the identity of mental patient. In the role of mental patient, he is no longer seen as a valid member of society. In fact he is an invalid.

With the label of mental illness, a whole new set of discriminations and problems must be overcome. There is a loss of rights. People can lose property, lose custody of children, lose privacy and lose due process before the law. They are basically taken out of the traditional legal system and placed in the extra-legal psychiatric system. The major task then in recovering from mental illness is to regain social roles and identities which are recognized as valid by oneself and the people in one¹s community. This may mean getting a job, being a volunteer, or becoming a student. It also means regaining rights, a process which the Americans with Disabilities Act of 1990 has greatly accelerated. Recovery often depends on finding someone who believes in you. That type of relationship can help a person to dream again.

People who have recovered from mental illness often do not believe that they have recovered. A colleague related that she had been diagnosed with schizophrenia in her early twenties. However, she has been out of the hospital for 10 years, has been off all medication for several years, and has contributed positively to the community through her full-time job and community service. When we said we thought she had recovered, she disagreed. She said she knew she had not recovered from mental illness because she still has periods when she gets very angry. These periods were never intense enough for her to lose her job or result in hospitalization. We pointed out to her that getting angry like that was a normal part of most people¹s life. Unfortunately, the label and identity of mental patient is so deep that we and the people around us continue to interpret life¹s normal swings of emotion as symptoms of continuing illness. After people have recovered from mental illness they still go through the emotional healing that everyone else is involved in. That is why the diagram shows that recovery is usually followed by the emotional healing.